1
|
Abstract
OBJECTIVE The purpose of this article is to review the clinical and imaging findings associated with eosinophilic lung diseases. CONCLUSION The spectrum of eosinophilic lung diseases comprises a diverse group of pulmonary disorders that have an association with tissue or peripheral eosinophilia. These diseases have varied clinical presentations and may be associated with several other abnormalities. Characteristic imaging findings are often detected with chest radiography, and CT best shows parenchymal abnormalities. The integration of clinical, radiologic, and pathologic findings facilitates diagnosis and directs appropriate treatment.
Collapse
|
2
|
Umezawa H, Naito Y, Ogasawara T, Takeuchi T, Kasamatsu N, Hashizume I. Idiopathic bronchocentric granulomatosis in an asthmatic adolescent. Respir Med Case Rep 2015; 16:134-6. [PMID: 26744680 PMCID: PMC4681958 DOI: 10.1016/j.rmcr.2015.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/18/2015] [Accepted: 09/18/2015] [Indexed: 11/24/2022] Open
Abstract
Bronchocentric granulomatosis in asthmatic patients has been generally considered to be associated with allergic bronchopulmonary aspergillosis and represent a histopathologic manifestation of fungal hypersensitivity. Here we report a case of an idiopathic bronchocentric granulomatosis in a 17-year-old man with a history of asthma. He was admitted to the hospital with a fever and cough, and a chest CT scan showed peribronchial consolidation in the pulmonary parenchyma, which was unresponsive to antibiotic therapy. The pathological findings obtained by video-assisted thoracoscopic lung biopsy revealed necrotizing granulomatous inflammation centered on bronchi and bronchioles and there was no evidence of fungal colonization, resulting in a diagnosis of idiopathic bronchocentric granulomatosis. Systemic corticosteroid therapy led to clinical and radiological recovery. Physicians should take into account the possibility of the idiopathic process in bronchocentric granulomatosis of asthmatic patients.
Collapse
Affiliation(s)
- Hiroki Umezawa
- Department of Respirology, Hamamatsu Medical Center, Japan; Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Yusuke Naito
- Department of Respirology, Hamamatsu Medical Center, Japan; Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | | | - Takao Takeuchi
- Department of Respirology, Hamamatsu Medical Center, Japan; Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | | | - Ikko Hashizume
- Department of Respirology, Hamamatsu Medical Center, Japan
| |
Collapse
|
3
|
Satsangi S, Acharya V, Kini H, Anupama K. An unusual cause of lung mass in a young female. Lung India 2014; 31:188-90. [PMID: 24778492 PMCID: PMC3999689 DOI: 10.4103/0970-2113.129894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sandeep Satsangi
- Junior resident, Department of Internal Medicine, Kasturba Medical College and Hospital, Mangalore, Karnataka, India E-mail: Sandeep satsangi:
| | - Vishak Acharya
- Associate professor, Department of Pulmonary Medicine, Kasturba Medical College and Hospital, Mangalore, Karnataka, India
| | - Hema Kini
- Professor and Head of Department of Pathology, Kasturba Medical College and Hospital, Mangalore, Karnataka, India
| | - Kv Anupama
- Junior resident, Department of Internal Medicine, Kasturba Medical College and Hospital, Mangalore, Karnataka, India E-mail: Sandeep satsangi:
| |
Collapse
|
4
|
Chowdhary A, Agarwal K, Kathuria S, Gaur SN, Randhawa HS, Meis JF. Allergic bronchopulmonary mycosis due to fungi other than Aspergillus: a global overview. Crit Rev Microbiol 2013; 40:30-48. [PMID: 23383677 DOI: 10.3109/1040841x.2012.754401] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Allergic bronchopulmonary mycosis (ABPM) is a hypersensitivity-mediated disease of worldwide distribution. We reviewed 143 reported global cases of ABPM due to fungi other than aspergilli. The commonest etiologic agent was Candida albicans, reported in 60% of the cases, followed by Bipolaris species (13%), Schizophyllum commune (11%), Curvularia species (8%), Pseudallescheria boydii species complex (3%) and rarely, Alternaria alternata, Fusarium vasinfectum, Penicillium species, Cladosporium cladosporioides, Stemphylium languinosum, Rhizopus oryzae, C. glabrata, Saccharomyces cerevisiae and Trichosporon beigelii. India accounted for about 47% of the globally reported cases of ABPM, attributed predominantly to C. albicans, followed by Japan (16%) where S. commune predominates, and the remaining one-third from the USA, Australia and Europe. Notably, bronchial asthma was present in only 32% of ABPM cases whereas its association with development of allergic bronchopulmonary aspergillosis (ABPA) is known to be much more frequent. The cases reviewed herein revealed a median IgE value threefold higher than that of ABPA, suggesting that the etiologic agents of ABPM incite a stronger immunological response than that by aspergilli in ABPA. ABPM is currently underdiagnosed, warranting comprehensive basic and clinical studies in order to elucidate its epidemiology and to devise a more effective therapy.
Collapse
|
5
|
Mukhopadhyay S, Gal AA. Granulomatous lung disease: an approach to the differential diagnosis. Arch Pathol Lab Med 2010; 134:667-90. [PMID: 20441499 DOI: 10.5858/134.5.667] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Granulomas are among the most commonly encountered abnormalities in pulmonary pathology and often pose a diagnostic challenge. Although most pathologists are aware of the need to exclude an infection in this setting, there is less familiarity with the specific histologic features that aid in the differential diagnosis. OBJECTIVE To review the differential diagnosis, suggest a practical diagnostic approach, and emphasize major diagnostically useful histologic features. This review is aimed at surgical pathologists who encounter granulomas in lung specimens. DATA SOURCES Pertinent recent and classic peer-reviewed literature retrieved from PubMed (US National Library of Medicine) and primary material from the institutions of both authors. CONCLUSIONS Most granulomas in the lung are caused by mycobacterial or fungal infection. The diagnosis requires familiarity with the tissue reaction as well as with the morphologic features of the organisms, including appropriate interpretation of special stains. The major noninfectious causes of granulomatous lung disease are sarcoidosis, Wegener granulomatosis, hypersensitivity pneumonitis, hot tub lung, aspiration pneumonia, and talc granulomatosis.
Collapse
Affiliation(s)
- Sanjay Mukhopadhyay
- Department of Pathology, State University of New York Upstate Medical University, Syracuse, New York 13210, USA.
| | | |
Collapse
|
6
|
Abstract
Granulomas in the lung are common diagnostic problems encountered by pathologists. They occur in a wide range of pulmonary conditions, ranging from common entities to uncommon ones and including both infections and non-infectious diseases. This review summarizes the main histological features that help distinguish various granulomatous lung diseases. It concentrates on the most important and common entities that may be encountered and emphasizes helpful features in the differential diagnosis.
Collapse
Affiliation(s)
- O A El-Zammar
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | | |
Collapse
|
7
|
Garrido L, Mata-Essayag S, Hartung de Capriles C, Eugenia Landaeta M, Pacheco I, Fuentes Z. Pulmonary histoplasmosis: Unusual histopathologic findings. Pathol Res Pract 2006; 202:373-8. [PMID: 16488088 DOI: 10.1016/j.prp.2005.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2004] [Accepted: 10/27/2005] [Indexed: 11/28/2022]
Abstract
Four patients with clinical diagnosis of interstitial lung disease (ILD) are presented. In these patients, lung biopsies revealed bronchocentric granulomatosis (BG), pulmonary alveolar proteinosis (PAP), diffuse alveolar damage (DAD), and in one biopsy, the clinical manifestations suggested tuberculous primo-infection with systemic dissemination. Three patients died without diagnosis. In all four cases, specific histological stains found Histoplasma capsulatum. Histoplasmosis may mimic other infectious or non-infectious pulmonary diseases, such as interstitial and granulomatous pulmonary disease. Therefore, the absolute need for identification of the organism by culture or special stains cannot be over-emphasized and may lead to a proper mycological diagnosis. This highlights the importance of differential diagnosis with systemic infectious diseases, especially in areas where deep-seated mycosis are endemic.
Collapse
Affiliation(s)
- Liseloth Garrido
- Complejo Hospitalario José Ignacio Baldó, and Sección de Micología Médica, Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela
| | | | | | | | | | | |
Collapse
|
8
|
Abstract
Allergic bronchopulmonary aspergillosis (ABPA) occurs in nonimmunocompromised patients and belongs to the hypersensitivity disorders induced by Aspergillus. Genetic factors and activation of bronchial epithelial cells in asthma or cystic fibrosis are responsible for the development of a CD(4)+Th2 lymphocyte activation and IgE, IgG and IgA-AF antibodies production. The diagnosis of ABPA is based on the presence of a combination of clinical, biological and radiological criteria. The severity of the disease is related to corticosteroid-dependant asthma or/and diffuse bronchiectasis with fibrosis. The treatment is based on oral corticosteroids for 6-8 weeks at acute phase or exacerbation and itraconazole is now recommended and validated at a dose of 200 mg/day for a duration of 16 weeks.
Collapse
Affiliation(s)
- I Tillie-Leblond
- Department of Pulmonology and Immuno-Allergology, University Hospital of Lille, Lille, France
| | | |
Collapse
|
9
|
Bondue B, Remmelink M, Gevenois PA, Yernault JC, De Vuyst P. A pulmonary cavitated mass complicating long-standing allergic bronchopulmonary aspergillosis. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.rmedx.2005.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
10
|
Cavazza A, Paci M, Turrini E, Dallari R, Rossi G. Fungus colonisation of pulmonary rheumatoid nodule. J Clin Pathol 2003; 56:636-7. [PMID: 12890823 PMCID: PMC1770030 DOI: 10.1136/jcp.56.8.636] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2002] [Indexed: 11/03/2022]
Abstract
This report describes a 69 year old woman, suffering from active rheumatoid arthritis since the age of 60 and presenting with severe dyspnoea and cough. A computed tomography scan of the chest showed multiple bilateral pulmonary nodules, sometimes cavitated, associated with reticular opacities and pleural effusion. A videothoracoscopic excision of a cavitated nodule was performed. Seven days after surgery, a right pneumothorax developed, and the patient died of septicaemia one month later. Microscopically, the excised nodule was composed of necrotic fibrinoid material with a peripheral rim of palisaded histiocytes, extending to the pleural surface and containing several fungal hyphae morphologically consistent with aspergillus. A diagnosis of pulmonary rheumatoid nodule with fungus colonisation was made. In the lung, fungus colonisation is a rare complication of rheumatoid nodules. The most important differential diagnostic considerations are briefly discussed.
Collapse
|
11
|
Abstract
Paul Ehrlich first described the eosinophil in 1879. It is a pro-inflammatory cell that is involved in the immune defense against various offenders in atopic and nonatopic individuals. Eosinophils derive from an unknown progenitor cell in the bone marrow. This article reviews the etiology and effects of this condition.
Collapse
Affiliation(s)
- Devang M Savani
- Division of Pulmonary and Critical Care Medicine, University of Southern California, GNH 11900, 2025 Zonal Avenue, Los Angeles, CA 90033, USA
| | | |
Collapse
|
12
|
Kim DH, Lee JH, Kim BH, Choi EK, Park JS, Kim KY, Choi YH, Myong NH, Lee KY. Chronic necrotizing bronchopulmonary aspergillosis with elements of bronchocentric granulomatosis. Korean J Intern Med 2002; 17:138-42. [PMID: 12164091 PMCID: PMC4531665 DOI: 10.3904/kjim.2002.17.2.138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Chronic necrotizing pulmonary aspergillosis (CNPA) is an unusual form of pulmonary aspergillosis arising in the setting of mildly immune compromised state or altered local defense system. CNPA rarely shows histological findings mimicking bronchocentric granulomatosis (BCG), which is characterized by peribronchiolar granulomatous destruction. We describe a case representing CNPA with elements of BCG. A-64 year-old woman was admitted because of atypical pneumonia with multi-focal variable sized consolidations and cavitary lesions on high-resolution computed tomography (HRCT). The open lung biopsy specimen showed large areas of necrotizing pneumonia with some scattered aspergillus hyphae within the lung parenchyma. Some terminal bronchioles were found to be destroyed and were replaced by peribronchiolar granulomatous inflammation. There was no evidence of angioinvasion by aspergillus or aspergillous emboli. Despite vigorous antifungal agent and steroid treatment, she died of acute airway obstruction by bronchial casts on the thirty-fourth hospital day.
Collapse
Affiliation(s)
- Doh Hyung Kim
- Dankook University Medical Center, Division of Pulmonary Medicine, 16-5 Anseo-dong, Chonan, Republic of Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Gotway MB, Dawn SK, Caoili EM, Reddy GP, Araoz PA, Webb WR. The radiologic spectrum of pulmonary Aspergillus infections. J Comput Assist Tomogr 2002; 26:159-73. [PMID: 11884768 DOI: 10.1097/00004728-200203000-00001] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Aspergillus infections may be categorized by specific radiographic patterns, the patient's immunologic status, and the presence or absence of preexisting structural lung disease. General patterns include invasive aspergillosis (both vascular and airway invasive varieties and acute tracheobronchitis), semiinvasive aspergillosis (including allergic bronchopulmonary aspergillosis and hypersensitivity pneumonitis), mycetoma, allergic aspergillosis, and obstructing bronchial aspergillosis. Knowledge of these various radiographic patterns as well as the immune derangements that accompany these infections may allow proper diagnosis.
Collapse
Affiliation(s)
- Michael B Gotway
- Department of Radiology, San Francisco General Hospital, San Francisco, CA 94110, USA.
| | | | | | | | | | | |
Collapse
|
14
|
Zinck SE, Schwartz E, Berry GJ, Leung AN. CT of noninfectious granulomatous lung disease. Radiol Clin North Am 2001; 39:1189-209, vi. [PMID: 11699668 DOI: 10.1016/s0033-8389(05)70338-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Noninfectious granulomatous diseases of the lung consist of a diverse group of disorders that logically can be subdivided into those with and without associated vasculitis. This article reviews the epidemiologic, clinical, pathologic, and radiologic features of sarcoidosis, hypersensitivity pneumonitis, berylliosis, and the five entities traditionally classified as pulmonary angiitis and granulomatosis.
Collapse
Affiliation(s)
- S E Zinck
- Department of Radiology, Stanford University Medical Center, California 94305-5105, USA.
| | | | | | | |
Collapse
|
15
|
Houser SL, Mark EJ. Bronchocentric granulomatosis with mucus impaction due to bronchogenic carcinoma. An association with clinical relevance. Arch Pathol Lab Med 2000; 124:1168-71. [PMID: 10923078 DOI: 10.5858/2000-124-1168-bgwmid] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe an unexpected inflammatory process associated with malignancy in the lung and to postulate a new mode of pathogenesis. DESIGN Retrospective review of surgical pathologic findings. SETTING Academic hospital pathology department. PATIENTS Four patients, 2 men and 2 women, ranging in age from 45 to 74 years, each of whom had a solitary mass on chest radiographs. INTERVENTIONS Pulmonary lobectomy. MAIN OUTCOME MEASURE Histopathologic identification of bronchocentric granulomatosis. RESULTS Accompanying a bronchogenic carcinoma in each case was a necrotizing chronic granulomatous reaction centered around bronchioles that were plugged with mucus, necrotic detritus from the tumor, lipid, or a combination of these substances. Eosinophils were present in small numbers in one case. The pathologic findings characterize bronchocentric granulomatosis. CONCLUSIONS The presence of bronchocentric granulomatosis in the biopsy of a mass does not exclude the presence of an accompanying bronchogenic carcinoma associated with obstruction of bronchioles. Bronchocentric granulomatosis in some cases may represent an immunologic response to tumor detritus or lipid, as well as to mucus impaction.
Collapse
MESH Headings
- Adenocarcinoma/complications
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Aged
- Bronchial Diseases/etiology
- Bronchial Diseases/pathology
- Carcinoma, Bronchogenic/complications
- Carcinoma, Bronchogenic/pathology
- Carcinoma, Bronchogenic/surgery
- Carcinoma, Large Cell/complications
- Carcinoma, Large Cell/pathology
- Carcinoma, Large Cell/surgery
- Carcinoma, Squamous Cell/complications
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Fatal Outcome
- Female
- Granuloma, Respiratory Tract/etiology
- Granuloma, Respiratory Tract/pathology
- Humans
- Lung Neoplasms/complications
- Lung Neoplasms/pathology
- Lung Neoplasms/surgery
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Mucus/cytology
- Retrospective Studies
Collapse
Affiliation(s)
- S L Houser
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | | |
Collapse
|
16
|
Ward S, Heyneman LE, Flint JD, Leung AN, Kazerooni EA, Müller NL. Bronchocentric granulomatosis: computed tomographic findings in five patients. Clin Radiol 2000; 55:296-300. [PMID: 10767190 DOI: 10.1053/crad.1999.0380] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM The aim of this study was to assess the CT manifestations of bronchocentric granulomatosis. SUBJECTS AND METHODS The CT results of five patients with bronchocentric granulomatosis were retrospectively analysed. The patients ranged from 20 to 72 years of age and included three men and two women. The diagnosis of bronchocentric granulomatosis was made at lobectomy (n = 2), open lung biopsy (n = 2), and transbronchial biopsy (n = 1). Only one of the five patients had asthma. RESULTS The main findings consisted of a spiculated mass lesion (n = 3) or lobar consolidation with associated mild volume loss (n = 2). One of the two patients with consolidation had extensive mucoid impaction. The abnormalities involved predominantly an upper lobe in four patients and a lower lobe in one patient. In the four resected specimens, the macroscopic pathological appearance was consolidation (n = 2) and mass lesion (n = 2). Microscopically, the typical histology of airway-centred necrotizing granulomata was present in all cases. Aspergillus hyphae were identified in two cases. Nocardia sp. was cultured from the biopsy specimen in one case. CONCLUSION The CT manifestations of bronchocentric granulomatosis consist of a focal mass or lobar consolidation with atelectasis. These reflect the presence of granuloma formation with or without associated bronchial obstruction.
Collapse
Affiliation(s)
- S Ward
- Departments of Radiology, Vancouver Hospital and Health Sciences Centre, University of British Columbia, 855 W. 12(th)Ave, Vancouver, BC, V5Z 1M9, Canada
| | | | | | | | | | | |
Collapse
|
17
|
Meghjee S, Campbell A, Greenstone MA. Multiple cavitating nodules in a patient with hemoptysis. Chest 1999; 115:1184-7. [PMID: 10208227 DOI: 10.1378/chest.115.4.1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- S Meghjee
- Department of Thoracic Medicine, Castle Hill Hospital, Cottingham, East Yorkshire, United Kingdom
| | | | | |
Collapse
|
18
|
Abstract
Chronic necrotizing pulmonary aspergillosis (CNPA) is a rare locally destructive form of chronic aspergillosis that is recognized as a clinical syndrome, but has been poorly defined histologically. In this study, 10 cases of CNPA were evaluated from a morphological perspective. Three distinct forms of CNPA emerged. One form (n = 4) resembled a necrotizing granulomatous pneumonia centered around a central zone of infarct-like necrosis of parenchyma resulting from angioinvasive aspergillus. The second pattern (n = 4) was that of a granulomatous bronchiectatic cavity with a central fungus ball and subtle tongues of necrosis and inflammation extending into and through the fibrous wall of the cavity. A final form (n = 2) had a bronchocentric granulomatosis-like appearance with a necrotizing granulomatous bronchitis/bronchiolitis associated with luminal necrotic debris and replacement of mucosa by a palisaded histiocytic reaction. Despite the varied histomorphology, all patients survived the aspergillus infection after antifungal therapy and surgical resection. The different forms of pulmonary aspergillosis are briefly discussed, and the differential diagnosis, with particular regard to mycetomas and allergic forms of bronchocentric granulomatosis, is highlighted.
Collapse
Affiliation(s)
- S A Yousem
- Department of Pathology, Montefiore University Hospital, University of Pittsburgh Medical Center, PA 15213-2582, USA
| |
Collapse
|
19
|
Mourad WA, Vallieres E, Power RF, Hirji M. Fine-needle aspiration cytology of bronchocentric granulomatosis: a potential diagnostic pitfall. Diagn Cytopathol 1996; 14:263-7. [PMID: 8732659 DOI: 10.1002/(sici)1097-0339(199604)14:3<263::aid-dc13>3.0.co;2-j] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Bronchocentric granulomatosis (BCTG) is a rare disease associated with bronchial asthma and bronchopulmonary aspergillosis. Idiopathic forms are rarely encountered. We report on a case of BCTG showing clinical, radiological, and cytological evidence suggestive of adenocarcinoma of the lung. The patient is a 69-yr-old female, lifetime nonsmoker with multiple sclerosis who was admitted with a history of ascending cholangitis. Admission chest X-ray documented a 1.5-cm nodule in the left upper lobe of the lung. This was confirmed by CT scan. The lesion was slowly growing. Bronchoscopic examination was normal. Bronchial brushings were inconclusive. A transthoracic fine-needle aspiration showed sheets of highly atypical epithelium with occasional small dyshesive clusters. There was an inflammatory background that was believed to represent tumor diathesis. The cytological interpretation was "suspicious for adenocarcinoma." The patient underwent left upper lobectomy. The lung showed multiple peribronchial granulomas with intense peribronchial lymphoid infiltrate extending into the bronchial mucosa, causing cytological atypia and focal ulceration. Special stains for microorganisms were negative. The patient recovered from surgery and shows no signs of infection. We conclude that BCTG and related lesions can give cytological features that are suggestive of malignancy. Cytological material obtained from these lesions should be interpreted with caution.
Collapse
Affiliation(s)
- W A Mourad
- Department of Pathology, University of Alberta Hospitals, Edmonton, Canada
| | | | | | | |
Collapse
|
20
|
Collier J, Wolfe R, Lerner R, Nathan S, Mohsenifar Z. Spinal aspergillus abscess in a patient with bronchocentric granulomatosis. J Intensive Care Med 1995; 10:45-8. [PMID: 10155170 DOI: 10.1177/088506669501000106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aspergillus fumigatus hyphae is often found in the lung tissue of patients with bronchocentric granulomatosis (BCG). This organism is believed to be one agent responsible for inciting the hypersensitivity response and subsequent development of the characteristic pathology that defines BCG. The definitive etiology of this disease, however, remains conjectural. Corticosteroids represent the mainstay of therapy. The fungi recovered from patients with BCG are considered noninvasive; thus, the risk of fungal invasion secondary to steroid-induced immunosuppression is believed to be negligible. However, we report a case of spinal aspergillus abscess that developed in a patient with BCG subsequent to steroid therapy. This case also highlights the necessity for aggressive medical and neurosurgical intervention to avert the development of neurological sequelae.
Collapse
Affiliation(s)
- J Collier
- Department of Medicine, Cedars-Sinai Medical Center, UCLA School of Medicine, Los Angeles, CA, USA
| | | | | | | | | |
Collapse
|
21
|
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 22-1994. A 57-year-old man with a chronic productive cough, dyspnea, and extensive bilateral air-space disease. N Engl J Med 1994; 330:1599-606. [PMID: 8177251 DOI: 10.1056/nejm199406023302210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
22
|
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 45-1993. A 23-year-old asthmatic man with pulmonary infiltrates and hilar lymphadenopathy. N Engl J Med 1993; 329:1484-91. [PMID: 8413460 DOI: 10.1056/nejm199311113292009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
23
|
Dikman SH. Asbestosis, endobronchial Aspergillus infection, and bronchocentric granulomatosis presenting with hemoptysis. Lung 1991; 169:25-30. [PMID: 2011042 DOI: 10.1007/bf02714138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A patient with pulmonary asbestosis developed hemoptysis and a lesion on chest radiograph secondary to bronchocentric granulomatosis (BG) associated with Aspergillus fumigatus. Although pulmonary Aspergillus infection is a known complication of asbestos exposure. BG has not been previously reported in this disorder. This patient's case further documents that Aspergillus hyphae may be present in BG unassociated with allergic bronchopulmonary aspergillosis. A wide range of processes affecting airways, including asbestos exposure, may be associated with bronchocentric granulomatosis.
Collapse
Affiliation(s)
- S H Dikman
- Department of Pathology, Mount Sinai School of Medicine, City University of New York, New York
| |
Collapse
|
24
|
Feinsilver SH, Fein AM, Niederman MS, Schultz DE, Faegenburg DH. Utility of fiberoptic bronchoscopy in nonresolving pneumonia. Chest 1990; 98:1322-6. [PMID: 2245668 DOI: 10.1378/chest.98.6.1322] [Citation(s) in RCA: 95] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Although fiberoptic bronchoscopy (FOB) has been traditionally used to evaluate nonresolving pneumonia, its efficacy is unknown. We, therefore, reviewed FOB in 35 consecutive patients who had (1) a roentgenographic infiltrate, (2) cough, (3) either temperature greater than 38.1 degrees C, leukocytosis, sputum production, (4) symptoms present for at least ten days, and antibiotic therapy for at least one week. Known lung cancer and AIDS were excluded. Fiberoptic bronchoscopy was diagnostic in 86 percent (12/14) in whom a specific cause was found. No patient had endobronchial cancer. Two patients with nondiagnostic FOB and persistent systemic symptoms had open lung biopsy specimens showing Wegener's granulomatosis and bronchiolitis obliterans with organizing pneumonia (BOOP). Twenty-one patients with nondiagnostic FOB had no final diagnoses other than community-acquired pneumonia. We conclude that FOB is extremely useful in finding a specific diagnosis for a nonresolving pneumonia when a specific diagnosis can be made. Fiberoptic bronchoscopy was most likely to yield a specific diagnosis in nonsmoking patients with multilobar infiltrates of long duration and could have been avoided in older, smoking, or otherwise compromised patients with lobar or segmental infiltrates with no decrease in diagnostic yield in our series.
Collapse
Affiliation(s)
- S H Feinsilver
- Department of Pulmonary and Critical Care Medicine, Winthrop University Hospital, Mineola, NY
| | | | | | | | | |
Collapse
|
25
|
Bhargava V, Tomashefski JF, Stern RC, Abramowsky CR. The pathology of fungal infection and colonization in patients with cystic fibrosis. Hum Pathol 1989; 20:977-86. [PMID: 2793162 DOI: 10.1016/0046-8177(89)90269-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We used methenamine silver stains to retrospectively evaluate the prevalence of fungi and their associated inflammatory reactions in 63 patients with cystic fibrosis (CF) autopsied between 1982 and 1987. Fungi were detected in 13 patients (21%) who fell into three groups: respiratory tract colonization (five patients); localized infection (five patients); and disseminated infection (three patients). Hyphae consistent with Aspergillus sp were present in five patients; yeast-like cells and/or pseudohyphae consistent with Candida sp occurred in eight patients; and Histoplasma capsulatum produced fibrocaseous lymph node and splenic granulomas in one patient. Acute inflammation typified most fungal lesions, while bronchocentric granulomatosis affected one patient. Compared with patients with no fungi, those with fungi were more frequently treated with indwelling central venous catheters (P less than .05). Autopsy reports on 156 CF patients from 1964 to 1982 disclosed only one with disseminated mycosis (P less than .05). We conclude that stainable fungi can be found in CF patients at autopsy more frequently than previously realized. Fungi usually represent respiratory tract colonization or minimal localized infection, but the prevalence of fatal disseminated infection (4.8%) has also increased. Fungal infection in CF appears to be most closely associated with aggressive therapeutic intervention.
Collapse
Affiliation(s)
- V Bhargava
- Department of Pathology, Cleveland Metropolitan General Hospital, OH 44109
| | | | | | | |
Collapse
|
26
|
|
27
|
|
28
|
|
29
|
Perales Marín F, Benlloch García E, Jordá Cuevas M, Marco Martínez V. Granulomatosis broncocéntrica. Un caso secundario a aspergillosis broncopulmonar alérgica. Arch Bronconeumol 1987. [DOI: 10.1016/s0300-2896(15)31931-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
30
|
Bonafede RP, Benatar SR. Bronchocentric granulomatosis and rheumatoid arthritis. BRITISH JOURNAL OF DISEASES OF THE CHEST 1987; 81:197-201. [PMID: 3651314 DOI: 10.1016/0007-0971(87)90141-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We report a 42-year-old patient with an 11-year history of rheumatoid arthritis (RA) who presented 8 years later with haemoptysis and was found to have multiple pulmonary opacities with histological features of bronchocentric granulomatosis (BCG). The association between BCG and RA is discussed and the literature is reviewed.
Collapse
Affiliation(s)
- R P Bonafede
- Department of Medicine, University of Cape Town, South Africa
| | | |
Collapse
|
31
|
Martinez Alfaro E, Herrero Huerta F, Ramos Freixa J, Sanchez Nieto J, Campillo Fuentes J, Page Del Pozo A. Hemorragia alveolar difusa en granulomatosis broncocentrica con aspergilosis asociada. Arch Bronconeumol 1986. [DOI: 10.1016/s0300-2896(15)32013-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
32
|
Abstract
We present a case of slowly progressive Aspergillus infection occurring in a partially immunocompromised host. The histologic pattern mimicked bronchocentric granulomatosis as seen in allergic bronchopulmonary aspergillosis, but the clinical history, spread of disease in the face of steroid therapy, peculiar granulomatous response to the organisms, and large numbers of organisms present suggest that this was really a case of chronic necrotizing pulmonary aspergillosis. These entities must be distinguished because their therapy, prognosis, and clinical significance are totally different.
Collapse
|
33
|
Abstract
Bronchocentric granulomatosis (BG) is an uncommon inflammatory lesion of unknown etiology defined on morphologic grounds by the presence of necrotizing granulomata centered on bronchi and bronchioles. We report the typical pathologic features of BG in a patient with tuberculosis. Mycobacterial and other types of infection should be excluded by appropriate stains and cultures in all patients with BG on lung biopsy, especially those who are nonasthmatic.
Collapse
|
34
|
Abstract
Bronchocentric granulomatosis is a chronic pulmonary disease treated with short-term therapy with corticosteroids, and the disease has an excellent prognosis. We describe a patient, and review an additional case from the literature, in whom bronchocentric granulomatosis was accompanied by glomerulonephritis. A misdiagnosis of Wegener's granulomatosis was made, and therapy with cyclophosphamide was either considered or given in each of these cases. We emphasize the need for careful histopathologic evaluation of open lung biopsies in patients suspected of having Wegener's granulomatosis in order to rule out the possibility of bronchocentric granulomatosis with concurrent renal disease, and thus avoid the unnecessary use of cytotoxic agents.
Collapse
|
35
|
Berendsen HH, Hofstee N, Kapsenberg PD, van Reesema DR, Klein JJ. Bronchocentric granulomatosis associated with seropositive polyarthritis. Thorax 1985; 40:396-7. [PMID: 4023996 PMCID: PMC460077 DOI: 10.1136/thx.40.5.396] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
36
|
|
37
|
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 50-1983. A 72-year-old woman with pulmonary infiltrates. N Engl J Med 1983; 309:1501-11. [PMID: 6646174 DOI: 10.1056/nejm198312153092407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
38
|
Abstract
Re-examination of the pathologic and clinical features of the entities traditionally classified under the heading "pulmonary angiitis and granulomatosis" indicates that there is little advantage in retaining this artificial category and that these entities should be considered variants of diseases to which they are actually related. Wegener's granulomatosis and allergic angiitis and granulomatosis appear to be examples of true systemic vasculitides in which the lung is a predominant but not the only or even the most important site of involvement. Wegener's granulomatosis may manifest with involvement limited to lung, a form that has been called limited Wegener's; however, many or most such cases progress to classic disease involving kidney and often upper respiratory tract. Similarly, Wegener's granulomatosis may present with disease limited initially to the upper respiratory tract (a form of midline granuloma); this process may also spread to involve lung and kidney. It seems unlikely that limited Wegener's is truly a separate disease category. Evaluation of the pathologic and clinical features of necrotizing sarcoid granulomatosis indicate that it very much resembles ordinary sarcoid in most histologic features, in the nature of extrapulmonary involvement, and in its clinical course and that it probably corresponds to the clinical--radiographic entity of nodular sarcoid. Lymphomatoid granulomatosis appears to have little relationship to the other members of the angiitis and granulomatosis group; its behavior and histologic features are those of a lymphoproliferative disorder that in most cases is or becomes histiocytic lymphoma. Some cases of so-called benign lymphocytic angiitis also fall into this category; the remainder appear to represent a variety of completely unrelated pathologic processes. Last, bronchocentric granulomatosis is most commonly one of the histologic manifestations of allergic bronchopulmonary aspergillosis, although it is likely that other agents or processes produce the same histologic pattern. Although the presence of a common set of pathologic features makes the concept of angiitis and granulomatosis attractive from a morphologic point of view, there is minimal clinical similarity among them, and these diseases appear to be totally separate entities.
Collapse
MESH Headings
- Acute Disease
- Aspergillosis, Allergic Bronchopulmonary/diagnosis
- Aspergillosis, Allergic Bronchopulmonary/pathology
- Diagnosis, Differential
- Glomerulonephritis/pathology
- Granuloma, Lethal Midline/pathology
- Granulomatosis with Polyangiitis/classification
- Granulomatosis with Polyangiitis/pathology
- Granulomatosis with Polyangiitis/therapy
- Humans
- Lung Diseases/pathology
- Lymphomatoid Granulomatosis/classification
- Lymphomatoid Granulomatosis/pathology
- Lymphomatoid Granulomatosis/therapy
- Necrosis
- Prognosis
- Pulmonary Eosinophilia/pathology
- Sarcoidosis/diagnosis
- Sarcoidosis/pathology
- Vasculitis/classification
- Vasculitis/pathology
- Vasculitis/therapy
- Vasculitis, Leukocytoclastic, Cutaneous/classification
- Vasculitis, Leukocytoclastic, Cutaneous/pathology
- Vasculitis, Leukocytoclastic, Cutaneous/therapy
Collapse
|
39
|
Roig Cutillas J, Morera Prat J, Sanjuas Benito C, Vidal Pla R, Ruiz Manzano J, Bernado Turmo L. Granulomatosis broncocentrica. Arch Bronconeumol 1983. [DOI: 10.1016/s0300-2896(15)32287-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
40
|
Hellems SO, Kanner RE, Renzetti AD. Bronchocentric granulomatosis associated with rheumatoid arthritis. Chest 1983; 83:831-2. [PMID: 6839832 DOI: 10.1378/chest.83.5.831] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
A 49-year-old woman with biopsy-proved bronchocentric granulomatosis (BCG) had repeated exacerbations of seronegative rheumatoid arthritis and vasculitis of the skin concurrent with BCG. To our knowledge, there have been no prior reports of this form of systemic involvement in BCG. While its pathogenesis remains obscure, this case, along with another recent report of eye involvement, suggests that BCG is part of a widespread immunologic response and is not a distinct entity.
Collapse
|
41
|
|
42
|
|
43
|
Abstract
Acute pulmonary disease is a major complication of immunodeficiency, and it has become increasingly important with the expanded use of immunosuppressive drugs. When routine clinical evaluation fails to identify a specific etiologic agent, a morphologic diagnosis is pursued by means of one or more invasive procedures. Interpretation of the material obtained by these procedures poses a challenge to pathologists. In this paper, the important histopathologic patterns of pulmonary disease likely to be encountered in this setting are reviewed, with emphasis on differential diagnosis. In addition, various diagnostic techniques are discussed and compared, with regard to interpretation of findings and diagnostic yields.
Collapse
|
44
|
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 24-1982. A 51-year-old woman with chronic asthma and hemoptysis. N Engl J Med 1982; 306:1471-9. [PMID: 7078592 DOI: 10.1056/nejm198206173062408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|